A long time coming...

I started interviewing patients yesterday. This may not seem like much, but it indicates that my very small project addressing perceptions of lumbar puncture (aka spinal tap aka LP) in Kampala, has begun! This is the project I originally came to work on in January 2009. Doing the right thing by applying to the Institutional Review Boards (research ethics committees, aka IRB) kept this project in limbo for a year and a half, but I now have approval from the University of Minnesota, the Infectious Diseases Institute, Makerere University, Mulago Hospital, and the Uganda National Council for Science and Technology. With a few letters and a nice research ID card, myself, two other medical students who are helping for a couple weeks , and a hired interpreter, went over to Ward 4A to start collecting data and interviewing patients and their family members about meningitis, LPs, assessing their medical knowledge (or lack of) and decision-making processes. We are also going to measure how long patients are in the hospital before (or if) they get a) an LP b) treatment c) a definitive diagnosis, and how they fare, whether or not they live and how long they were in the hospital. Ultimately, we want to use the information from the interviews to develop educational materials for patients and their families explaining meningitis and the spinal tap procedure and also to educate physicians as to why patients refuse and what they can do to prevent it from happening. Yay!

This project, aptly named “Perceptions of Lumbar Puncture for the Diagnosis and Treatment of Meningitis in Kampala, Uganda,” came to fruition just as so many other projects are also speeding up. I am currently collecting data from Mulago Hospital Records and the Microbiology department to see trends of a certain kind of fungal meningitis seen mostly in AIDS patients, Cryptococcal Meningitis (CM), over the past ten years. The deal is, drug therapy for AIDS became widely available in Uganda in 2004 and so we want to see whether the rates of CM have decreased since then because theoretically, more patients would have been on treatment and less would be sick. But on the Infectious Disease Ward at Mulago, we see a ton of CM and so we are checking out this theory. Another future project based on this would be that once we get the rates (by month and year), we could compare it to weather data and check the seasonal variation of the disease.

The Infectious Diseases Institute now has a low-tech kind of EMR (Electronic Medical Record), and a few databases tracking patient data. They want to cross-check these databases – specifically the pharmacy, clinic, and laboratory data – and find the real rates of certain infections that are common. A friend of mine has done this for Tuberculosis, and I will do this for CM. The public health courses I am taking right now through the University of Minnesota – Introduction to Epidemiology and Biostatistics – have definitely given me a better sense of what I am looking for and how to go about designing these new projects.

The big clinical trial that I am preparing for (the COAT trial) is chugging along. Last week we submitted many documents to be transformed into database-friendly forms to be barcoded and uploadable. There is this new program through the National Institutes of Health called DataFax, that scans all of our completed patient documents and automatically enters the info into a database. It may sound boring, but is going to save us a lot of time and prevent a lot of missing documentation. We also find out in April whether the trial will be funded and will have a better idea of when it could start.

Grant recently finished developing a bunch of documents for the neurocognitive assessment project that will be starting in March or April. Although we work together in the same office, we don’ t usually “work” on the same things. But his project will share patients with the COAT trial so we have been working together a bit to make sure it all flows together. Sometimes this can cause tense moments, as neither of us like being told what to do, and both of us are always right.

Our evenings have been pretty busy lately, but not like they normally are. We are making a concerted effort not to go out during the week. This isn’t too tough considering I have basketball practice two nights a week and my online public health courses take up the rest of the nights. And Grant makes it easy for me to get work done because he is busy playing poker, either at the casino or online. But we still manage to keep up with the Kampala crowd and accommodate visitors from all over. There is always a birthday celebration or going away party, rugby to watch and pork joints to patronize, and now that we have been here awhile we have house-warmings and baby showers to attend!

Decklin - the owner of Bubbles, watching 6 Nations Rugby

Grant and Friends at Guy and Allison's housewarming party

Grant, myself, and Rosie out at Emin Pasha for her birthday

Some of my basketball teammates and I out for pork

And then Grant did some surprise planning (with some help from our wonderful friends), and VOILA…a beautiful Valentines weekend. He sprang for a room at the Serena Hotel in Kampala on Saturday night, and we stayed through Sunday to use their workout facilities and huge pool. It was so nice that we thought about getting a membership at their gym…until we realized their corporate rate listed was per person. Ouch! We got home in time to clean up and head to a very romantic dinner at the Chapter One Restaurant at the Protea. Champagne, a bouquet of roses, live music, and amazing food provided a wonderful end to the weekend.

Dinner at Chapter One (Protea Hotel) - February 14, 2010

Cape Town, South Africa

We ended up buying some last minute plane tickets to Cape Town, South Africa following our trip to Zanzibar. We flew in on the 19th of January with a layover in Johannesburg. Maiken met us at the Cape Town airport and we decided to rent a car for the week…a tiny little Hyundai. Ann did all the driving and conquered the whole driving on the wrong side of the road using your left hand to shift thing. We all stayed at the Ashanti Lodge Gardens hostel, which was a nice hostel...although our room was right next to where everyone hung out at night making it difficult to fall asleep. We got settled in and went out to Long Street for dinner and drinks with Justin, who had been in Cape Town working a number of months at a few hospitals. Long St. is very much like Haight St. in San Francisco with lots of bars and interesting places to eat. Not as many head shops, but that’s California for you. Had probably the best burgers since we came to Africa at the Royale Eatery. Afterwards we went to the Dubliner and listened to a brother/sister combo perform covers of American music. I was amazed at this Westernized version of Africa. Cape Town is unlike anything I have seen in Africa (admittedly I haven't seen that much)and it felt like we had gone back to the states or maybe Europe.


It's got a hemi.

We went to the Victoria & Alfred Waterfront our first full day in the city. It’s a functioning port and there were plenty of ships around, however the area with the tourists is full of tour boats including a sweet replica of a pirate ship. We had some very good sushi at Wang Thai…another first in Africa. Unfortunately we were unable to take the ferry to Robben Island, the location of Nelson Mandela’s prison, as it was booked. Had some nice steaks at Nelson’s Eye, an old steakhouse which was conveniently a half a block from our hostel. Ann finally got some of her beloved crème brulee for dessert. It wasn't as good as we've had before, although it's something that we haven’t seen in a while.

The next day consisted of a wine tour to four wineries around Stellenbosch and Paarl in the heart of wine country, just east of Cape Town. The first was Fairview which had wine and cheese tasting. Good cheese is nearly impossible to find in sub-saharan Africa and that was possibly more delicious than the wine! For lunch we stopped at a winery with a restaurant and had some bibooti(sp?), a traditional Afrikaans dish. Also went to Solms, Tokara, and Villiera. At Villiera we were treated to some sparkling wine opened with a sword. Ann and I bought 7 bottles total, 5 of which we took back to Kampala. Also bought some cheese (garlic-parsley camembert and sun dried tomato chevin). Went to Tank in the Cape Quarter for dinner. We both had sushi again…mine was good, however I don’t think Ann was too impressed.


Wine country...


Sleep it off...

The 22nd of January marks the day Ann cut her hair, removing over a foot of length! It was quite a drastic change, but I love it. I almost forget that it used to be much longer. Made our way south to the Cape of Good Hope and Cape Point. Along the way we stopped to eat in Hout Bay at Mariner’s Wharf, which had some great seafood and shockingly good bread. I was introduced to the Grapetiser, a sparkling grape juice. I proceeded to drink these the rest of my time in South Africa. The drive south from Cape Town is quite beautiful. You’re basically driving on the side of the mountains following the coast to the southern most point of the peninsula. We stopped in Simonstown to see the penguins at Boulder Beach. Penguins are strange creatures and quite hilarious. Most of the time they stood there with their eyes closed and beaks open pointing upwards. When they would walk around I could hardly keep from laughing. A few were playing in the water and many were keeping their babies warm. For dinner we went to the the place Justin was staying (Ivor and Shifra, some of Justin’s family) for Shabat dinner. I even got to wear a yamukah. Since we had meat, there were no dairly products, however we had a non-dairy ice cream. It was surprisingly good.


Hout Bay


Absolutely no shaking hands with the penguins.


They used to be called jackass penguins...


...but that hurt their feelings. Please refer to them as African penguins.


You can see the road we were driving...


Random view heading south towards Cape Point.

The following day involved an early morning hike up Table mountain. It was a steep hike up large stone steps, like the ultimate stairmaster workout. Maiken and Ann handled it much better than I did…probably because I’m in much better shape than those two. Or maybe it’s the other way around. We took the cable car down, which was a quick 2 minutes compared to our 1.5 hour hike. Ann and I moved to a nice room in a different building, so the following nights allowed for much easier sleep than right next to the pool in our previous room. We drove to Camps Bay to enjoy Clifton 4th beach. It was very warm out and the water looked so nice. A few people were enjoying diving into the large waves breaking at the beach. Unfortunately, the best we could do was to put our feet in the water...once we did they instantly went numb. The ocean current in Cape Town comes directly from Antarctica, so it’s a tad bit like an ice bath. Saw a lawn bowling club near the beach with a bunch of old, white men in funny uniforms (goofy hats, polos and white trousers) rolling a ball towards other balls. That night we met a friend of a friend for dinner and jazz at the Rainbow Room. Before the show the host gave our group of medical professionals from America a shout out, which was cool and embarrassing. A group of teens from a local school performed first followed by Abigail Peterson, who was a wonderful singer/pianist. We had a good time, but were kind of falling asleep by the end. Apparently we're reaching that age...


On top of Table Mountain.


Cape Town from the top of Table Mountain.


Look at those athletes giving it their all.

The next day Ann and Maiken went for a 10 mile run along the coast and they say it was quite beautiful. We spent the day with Maiken and Justin at Canal Walk, a large shopping mall in a suburb. It was one of the nicer malls I’ve been in. The food court was very interesting with a large selection of things I’ve never seen before and of course McDonald’s and KFC, where everyone seemed to be eating. Had some tasty beef shwarma at a falafel place. When you ordered your meal they hit a button indicating what kind of meat the cooks should prepare…justin ordered the lamb and I had the beef. We both enjoyed the silly baaaa and mooooo recordings for our respective meats. Not sure if others see the humor in that, but we do. After searching all over Africa Ann finally was able to find a pair of basketball shoes. She has been practicing with her team, and their season starts in March. I’m excited to see her out there…I think she’ll be the only white person in the entire league, so she’ll probably have her own fan club! Of course I’ll be president. That night we ate at Arnold's, where I had the game platter containing an ostrich fillet, oryx fillet, crocodile ribs and warthog ribs. The oryx and warthog were especially good. Crocodile is a novelty, but not anything special. We then went to see Goldfish, a musical duo from Cape Town, who play a club night every Sunday at the same place right near the beach we had been to. It was packed and the indoor area was roasting. Luckily we were able to secure a nice spot at a table which allowed us to drink our illegally brought in box of wine. Nothing says classy like sneaking in a box of wine and drinking it with styrofoam cups.


Staying classy.


Dinner at Arnolds's.

The following day we flew back to Entebbe. It was a difficult transition as we both seemed to be a little homesick after being in a city so much like what we are used to back home. Although we're halfway through our time here...I imagine the rest of the time will fly by.

The past few weeks our two bosses from the U of Mn have been here along with the deans of our medical school and the school of public health and other high ranking officials from the U of Mn, so we’ve been involved in a few meetings and meals talking to the officials about our experience here. They’re exploring their connection with Makerere University and the IDI to see how it can be more significant. It was kind of fun to be ambassadors of a sort. Ann has started work on her public health certificate from the U of Mn. Between that, basketball, work and socializing she is quite busy. I don’t know how she does it, but she’s probably the most motivated person I know so I’m not surprised that she does!